Type 2 Diabetes Associated With Short-Term Risk for Fracture

Type 2 diabetes is associated with increased risk for fractures in the short term but not in the long term.

Type 2 diabetes (T2D) is associated with increased risk for fractures in the short term but not in the long term, according to study results presented at the American Association of Clinical Endocrinologists 28th Annual Congress, held April 24 to 28, 2019, in Los Angeles, California.

Patients with T2D tend to have normal or high bone mineral density. However, fracture risk is increased in older adults with T2D compared with patients without T2D. The goal of this study was to investigate the association between T2D and short- and long-term fracture risk.

Researchers from Harvard Medical School in Boston, Massachusetts, identified men and women participating in the Framingham Original and Offspring Cohorts who took part in an osteoporosis study visit at baseline. They analyzed the association between diagnosis of T2D, use of medication to treat T2D, and duration of T2D with incident fracture, excluding fractures of the finger, toe, skull, or face, as well as pathologic fractures. Adjustments were made for age, sex, height, and weight.

The study enrolled 2105 women and 1130 men, 9% of whom had T2D (mean age, 67 ± 10 years). Median follow-up was 9 years and was measured until incident fracture, mortality, loss to follow-up, or end of follow-up in 2009. Diagnosis of T2D was more common in men vs women (13% vs 7%), but T2D medication use was more common in women compared with men with T2D (63% vs 51%, respectively). Mean T2D duration was 8 ± 7 years.

In women, T2D was associated with higher cumulative fracture incidence compared with women without T2D (37% vs 30%, respectively). However, in men, cumulative fracture incidence was lower in men with T2D compared with men without T2D (11% vs 16%, respectively). Diagnosis of T2D was associated with more than 2-fold 1-year fracture risk in women (hazard ratio [HR], 2.23; 95% CI, 1.13-4.42), but this association was not present in men.

With regard to duration of diabetes, the researchers reported a 28% increase in fracture risk for every 5-year increase in T2D duration (HR, 1.28; 95% CI, 1.03-1.59). Use of T2D medications was associated with 70% increase in 2-year fracture risk (HR, 1.70; 95% CI, 1.01-2.85).

Of note, the researchers reported that there was no significant association between T2D and long-term incidence of fracture.

Given an increased imminent risk for fracture in patients with T2D, “clinical intervention may be particularly effective for fracture reduction in older adults with T2D,” concluded the researchers.